Exercise-induced silent myocardial ischemia in master athletes.
High-physical activity levels are associated with reduced risk of symptomatic coronary artery disease (CAD). However, there are a number of reports of exercise-related sudden death and myocardial infarction in aerobically trained athletes. This study compared the prevalence of exercise-induced silent myocardial ischemia on maximum graded exercise tests with tomographic thallium scintigraphy in 70 master male athletes (63 +/- 6 years, mean +/- SD) (maximum aerobic capacity, VO2max >40 ml/kg/min) and in 85 healthy untrained men (61 +/- 7 years) with no history of CAD. The prevalence of silent ischemia (exercise-induced ST-segment depression on electrocardiogram and perfusion abnormalities on thallium scintigraphy) was similar in athletes and untrained men; 16% of the athletes (11 of 70) had silent ischemia compared with 21% of the untrained men (chi-square = 0.81, p = 0.36). No athletes had hyperlipidemia, systemic hypertension, or diabetes mellitus. However, the apolipoprotein E4 allele was present in 9 of the 11 athletes with silent ischemia compared with 2 of 32 athletes with normal exercise tests (chi-square = 24, p = 0.0001). These results suggest that older male athletes with the apolipoprotein E4 allele are at increased risk for the development of exercise-induced silent ischemia.
Katzel
L I
LI
Department of Medicine, University of Maryland School of Medicine and Geriatric Research Education and Clinical Center, Baltimore VA Medical Center, 21201, USA.
Fleg
J L
JL
Busby-Whitehead
M J
MJ
Sorkin
J D
JD
Becker
L C
LC
Lakatta
E G
EG
Goldberg
A P
AP
D000368:Aged; D015444:Exercise; D005080:Exercise Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D010101:Oxygen Consumption; D011877:Radionuclide Imaging; D013177:Sports; D013794:Thallium Radioisotopes
D013794:Thallium Radioisotopes